Comparable Outcome of Alternative Donor and Matched Sibling Donor Hematopoietic Stem Cell Transplant for Children with Acute Lymphoblastic Leukemia in First or Second Remission Using Alemtuzumab in a Myeloablative Conditioning Regimen

Alana A. Kennedy-Nasser, Catherine M. Bollard, G. Doug Myers, Kathryn S. Leung, Stephen Gottschalk, Yiqun Zhang, Hao Liu, Helen E. Heslop, Malcolm K. Brenner, Robert A. Krance

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39 Scopus citations

Abstract

HLA-matched sibling donor (MSD) stem cell transplantation can cure >60% of pediatric patients with acute lymphoblastic leukemia (ALL), but <30% of patients will have a sibling donor. Alternative donor (AD) transplantation can be curative but has a higher risk of graft-versus-host disease (GVHD). The addition of alemtuzumab (Campath 1-H) to AD transplants produces in vivo T cell depletion, which may reduce the risk for GVHD. We now report the outcome for 83 children with ALL (41 MSD, 42 AD) undergoing stem cell transplantation in first or second complete remission. All patients received myeloablative conditioning, including cyclophosphamide, cytarabine arabinoside, and total-body irradiation, with alemtuzumab administered to AD recipients. GVHD prophylaxis consisted of a calcineurin inhibitor with either short-course methotrexate or prednisone. Disease-free survival (DFS) for MSD recipients was 72.3% (95% confidence interval [CI], 55.4%-83.6%) versus 62.4% (95% CI, 45.2%-75.4%) for AD recipients. The 100-day mortality was 7.1% in the AD group and 2.4% in the MSD group. Relapse rates were identical (24%). Treatment-related mortality, principally viral infection, explained the difference in survival. For children undergoing stem cell transplantation (SCT) from alternative donors, alemtuzumab with a myeloablative conditioning regimen resulted in DFS comparable to MSD.

Original languageEnglish (US)
Pages (from-to)1245-1252
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2008

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Keywords

  • Acute lymphoblastic leukemia
  • Alternative donor stem cell transplantation
  • GVHD
  • Leukemia relapse

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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